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Comparison of diabetes mellitus and insulin resistance screening methods for women with polycystic ovary syndrome
Fertility and Sterility, 08/15/2011
Hurd WW et al. – Women with polycystic ovary syndrome (PCOS) should be screened for Pre–diabetes mellitus (DM) and DM using glucose tolerance test (GTT) or hemoglobin A1c (HbA1c), and those with Pre–DM or DM are presumed to have insulin resistance (IR). In the rest, IR can be detected using either homeostasis model assessment (HOMA) or insulin levels.
Methods- Prospective study
- Adult women with PCOS (n = 111) were enrolled in the study.
- Subjects were screened for pre-DM and DM using a 2-hour GTT, HbA1c, or fasting plasma glucose (FPG) and for IR using HOMA, insulin levels (fasting and 2 hours after 75 glucose load), or obesity.
- Screening approaches were compared using positive and negative percent agreement and Cohen’s kappa (k).
- DM and pre-DM were diagnosed by GTT in 4% and 20% of subjects, respectively.
- Screening with FPG failed to identify 41% of pre-DM and 20% of DM subjects.
- GTT and HbA1c had only fair agreement (k = 0.29).
- IR was diagnosed in 24% of subjects with pre-DM or DM and in 56% of the remaining subjects using HOMA and insulin levels.
- HOMA and elevated insulin levels demonstrated substantial agreement for detecting IR (k = 0.70–0.73).
- Obesity demonstrated fair to slight agreement (k = 0.33–0.18).
